Mechanisms of Concussion and Ulnar Collateral Ligament Injury in Sports: Criteria and Rationale for Return to Play

Thursday, October 23, 2025

12:45 PM - 2:15 PM MT

Location: Kiosk 8

Primary Author(s)

DH

Di Huang, MD

Student
Johns Hopkins Bloomberg school of Public Health
Baltimore, Maryland

Co-Author(s)

David Cifu, MD (he/him/his)

Chair
VA Commonwealth Univ/Med Coll of VA
Richmond, Virginia

Poster Presenter(s)

William J. Lew, Other

Medical Student
University of Hawaii, John A. Burns School of Medicine
Honolulu, Hawaii

Co-Author(s)

BS

Brent Shimoda, Other

Medical Student
University of Hawaii, John A Burns School of Medicine
Honolulu, Hawaii
Eli M. Snyder, Other

Medical Student
University of Hawaii at Manoa, John A. Burns School of Medicine
Honolulu, Hawaii
Kai Sheng Khor, MD

Postdoctoral Research Fellow
Johns Hopkins University PM&R Program
Baltimore, Maryland
Henry L. Lew, MD, PhD (he/him/his)

Professor
VCU and U of Hawaii
Honolulu, Hawaii

Disclosure(s):

David Cifu, MD: No financial relationships to disclose

William J. Lew, Other: No financial relationships to disclose

Eli M. Snyder, Other: No financial relationships to disclose

Kai Sheng Khor, MD: No financial relationships to disclose

Henry L. Lew, MD, PhD: No financial relationships to disclose

Background and/or Objectives: Return-to-play (RTP) readiness is key in managing baseball injuries, particularly ulnar collateral ligament (UCL) injuries and concussions. UCL injuries from repetitive throwing stress and concussions from external head impacts present significant challenges to athletes. Despite existing RTP criteria, inconsistencies persist in clinical practice. This systematic review compares RTP criteria for UCL injuries and concussions, evaluating rehabilitation processes, objective testing methods, and challenges in ensuring safe return to sport.

Design: Systematic review following the PROSPERO protocol (CRD42024607322) and PRISMA guidelines.

Setting : Data were collected from studies examining RTP criteria and outcomes for UCL injuries and concussions in baseball players across various competitive levels.

Participants : Eligible studies included athletes with UCL injuries managed either surgically or nonoperatively and those with sport-related concussions. 41 articles were included after full-text screening.

Interventions: Analysis of rehabilitation strategies, RTP assessment tools, and success rates for UCL injuries and concussions.

Main Outcome Measures: Primary outcomes included RTP rates, recovery timelines, predictive assessment tools, and secondary injury rates. For UCL injuries, RTP success was measured by return to prior level of competition and recurrence of injuries. For concussions, neurocognitive recovery and adherence to sport-specific RTP protocols were analyzed.

Results: RTP after UCL surgical reconstruction in professional pitchers ranged from 79-91%, with 71-90% returning to the same level of play. Recovery took 12–18 months, with a 46% secondary injury rate. Nonoperative management in high school players had a 83.6% success rate, with stress ultrasound proving useful in predicting outcomes. Concussion RTP protocols varied, with MLB requiring a 7-day minimum, while other leagues used symptom-based assessments. Neurocognitive and reactive testing were key RTP determinants, with recovery timelines ranging from weeks to months.

Conclusions: RTP criteria for UCL injuries rely on functional milestones, while concussion RTP prioritizes cognitive recovery. Integrating biomechanical and neurocognitive assessments may improve safety. Standardized RTP models are needed to optimize both physical and cognitive readiness.